Brief Communication Scientific exploration on physiological basis of Karma (Sudation): A clinical application of heat stress.

Saurabh Yadav1, Vandana Verma2, Abhinav3

1Assistant professor, Himalayiya Ayurvedic P.G. Medical College& Hospital,Dehradun, India. 2Assistant professor, Department of KriyaSharir, Faculty of , Institute of Medical Science,Varanasi, India. 3Assistant professor, Department of KayaChikitsa, Faculty of Ayurveda, Institute of Medical Science,Varanasi, India.

ABSTRACT Now researchers have focused attention on exploring the mechanism of acute responses of heat stress given in heat therapy that ultimately promotes the long term health benefits. Heat therapy is not a new idea rather it was practiced since thousands years back in the form of hot bath, sauna bath, steam room. Similarly in Ayurveda there is very comprehensive description of heat therapy in the form of Svedan karma (Sudation therapy). Svedan is a process to induce sweating artificially in a patient who had already undergone Snehan. Svedan is applied for purification of body, as well as in management of various disorders originated due to vitiation of Vata, Kapha , Meda Dhatu and musculoskeletal disorders. It produces various beneficial effects by augmenting the like clears the channels, liquefies the deposited Dosha, regulates Vata Dosha, helps in removal and pacification of Dosha, augments metabolism (Agni Deepan), increases appetite, flexibility in body parts, softness and shining of skin, removes coldness, stiffness, drowsiness, improves joint motility. However, Svedana karma is vastly used by Ayurveda Physicians in treatment of various disorders but the mechanisms of beneficial effects produced by Svedan Karma are yet not completely explored on scientific basis. In this article, we will discuss and try to establish a possible mechanism of action of Svedana karma in relation to heat stress, mitochondrial adaptation, heat shock protein (HSP) and glucocorticoids as these are secreted under stressful conditions.

Keywords: Heat therapy, Svedana(Sudation), Panchkarma, Heat shock protein

INTRODUCTION Pitta dosha, Vyana and SamanaVata and Svedavahasrotas. Excessive and less sweating has been described as a Svedana karma (Sudation) is a procedure to induce sweating by characteristic in various disorders like Kushtha, Vatarakta and heating the body. It is of two kinds i.e. Saagni and Niraagni. excessive sweating in MedaRogas, Jwar. (Charak Samhita In SaagniSveda, sweating is induced by applying external heat Chikitsasthana 7/12; 29/16; Charak Samhita Sutrasthana 21/4). via various methods; it is similar to passive heat therapy. While When an individual adopts unhealthy dietary regimen for long in NiragniSveda, sweating is induced without application of time the Dosha get vitiated. The vitiated Dosha circulate in external heat rather heat generation in body is increased by whole body and get lodged in various channels (Khavaigunya) adopting certain measures e.g. doing exercise, heavy clothing and produce various ailments in them. etc. Svedana is used as Purvakarma (pre-procedure) before Ayurveda has advised various measures to balance Panchak-arma procedures and also as main treatment modality VriddhaDosha among them are Purvakarma (Snehana and for pacification and removal of VriddhaDosha. Tridosha are Svedan), PradhanaPanchakarma i.e. five procedures to remove biological entity present in each and every cell of the body, Mala i.e. vitiated Dosha and toxins accumulated in the Srotas responsible for both physiological and pathological states in the from body by targeting the different Srotas i.e. Purishavha, body. Sweating is produced because of Ushna property (hot Mutravaha, SvedavahaSrotas. Purvakarma (pre-procedures) is potency) of Pitta Dosha. Sweating is a physiological done before Panchakarma and by applying Purvakarma i.e. phenomenon for temperature regulation of the body and also Snehan and Svedan, the accumulated Dosha in minute Srotas helps in excretion of various metabolites. There is gets mobilized to Kostha. physiological variation in quantity and quality of sweat as per Ayurveda scholars were well acquainted with the function psychosomatic constitution (Charak Samhita Vimanasthana of sweat and Svedavahasrotas like eliminating toxins have 8/96). Normal sweating reflects the physiological state of the successfully designed and introduced as the SvedanChikitsa. Svedan is a process to induce sweating artificially in a patient 2Corresponding author :VandanaVerma who had already undergone Snehan etc. Effects produced by E-mail: [email protected] Svedan are it liquefies the , (eliminates the metabolic Received Jul25, 2019; Accepted Aug 13, 2019; Published Aug 31 waste), clears the obstruction of channels (improves circulation, 2019 exchange across cell membrane), reduces water retention i.e. doi: http://dx.doi.org/10.5667/tang.2019.0012 reduces Stambha (stiffness), Vatanulomana and directs the ©2019 by Association of Humanitas Medicine This is an open access article under the CC BY-NC license. Dosha to selective places from where they can be expelled (http://creativecommons.org/licenses/by-nc/3.0/) easily. TANG / www.e-tang.org 2019 / Volume 9 / Issue 3 / e4 1 Scientific exploration on physiological basis of Svedana Karma (Sudation): A clinical application of heat stress.

Snehan and Svedan are majorly used procedure out of REVIEW AND DISCUSSION ShadvidhaChikitsaUpkrama, so there is need to explore the possible mechanism of action of Svedan in relation to Svedan Karma contemporary science because the people of present era are Svedan Karma is one of the important procedures in more inquisitive about mechanism of action and they are not Poorvakarma and Shadvidhupakram employed for the much aware to Dosha principles. So in this review article mode treatment of various diseases or removal of VriddhaDosha from of action of Svedan Karma is explained with help of available the body. Principally, Svedan (fomentation) is designed to literature of traditional and contemporary science. induce sweating by application of heat. It may be administrated as Poorvakarma or chief procedure or Paschata Karma. In Svedan Karma sweating is induced by application of external MATERIALS AND METHODS heat to the body (SaagniSveda) or heat production is increased by adopting some modality (NiraagniSveda) like A comprehensive study was undertaken on the descriptions of Vyayam(physical activity), Gurupravarna (warm clothing)etc. Svedan karma, Purvakarma found in different Ayurvedic As a matter of fact secretion of sweat is the physiological Samhita. Descriptions were collected from various Ayurvedic function of the body, but some artificial means can be Samhita and research papers published in scholarly journals employed for increased production of sweat in various diseases were searched online from scientific electronic databases viz. especially associated with stiffness, heaviness and coldness. PubMed, Google scholar, Science Direct by using the following Depending upon the etiology, severity and symptoms of the key phrases: sweating, effects of Svedan karma, Panchakarma, disease, it may be either RukshaSvedan (without prior oleation stress response to heat and application of heat therapy. Results therapy) or SnigdhaSvedan (with prior oleation therapy) or were analyzed in view of contemporary science to understand Niragni (without external application of heat) and the physiological basis of Svedan Karma and its applications SaagniSvedan (application of external heat). It has a significant described in Ayurveda. role in curing the various diseases but due to faulty intervention may result in various complications. So it is always

As per Sthana (site) As per Agni (heat application) Aa per Guna (property) 1.Ekanga Sveda 1.Sagni 1.Ruksha Sveda DvividhaBheda(2 2. SarvangaSveda 2.Niragni 2. SnigdhaSveda types) (Charak Samhita Sutrasthana (Charak Samhita Sutrasthana (Charak Samhita Sutrasthana 14/65-66) 14/64-65) 14/64-65) TrividhaBheda As per RogiBala&Rogabala(strength of disease and patient ) (3types) 1.Mridu 2. Madhya 3. Maha(Charak Samhita Sutrasthana 14/7) Chaturvidha 1.Tapa 2. Ushma 3. Upanaha 4. Drava ( Chikitsathana 32/3) (4 types) Saptavidha 1. Loshtha 2. Vashpa 3. Agni 4. Ghati 5. Jala 6. Phala 7. Baluka (Harita Samhita Fourth Sthana 4/1) (7 types) 1. Hasta 1. Mamsa 1. Sankar 2. Pradeha 2. Urada&Tila 2. Prastara 3. Nadi 3. Baluka 3. Pariseka 4. Prastar 4. Kumbhi 4. Nadi Ashtavidha 5. Sankar 5. Pinda 5. Droni (8 types) 6. Upanaaha 6. Ishtika 6. Jala 7. Avagaha 7. Prastar 7. Upakoshtha 8. Pariseka 8. Sankar 8. Kuti (Kashyapa Samhita Sutrasthana (Vangsen) (Bhela Samhita Sutrasthana 22/1) 23/25-26) 6.Bhaya (Fear) 1. Vyayama (Exercise) 7.Krodha( Anger) Dashavidha 2.UshnaSadan (warm Rooms) 8. Upanaha (Poultice) (10 types) 3. Guru Pravarana (Heavy Clothing) 9.Avaha (War) 4.Kshudha (Hunger) 10.Atapa(Sunbath) (Sushruta Samhita Chikitsathana 5. Bahupana (Excessive Drinking) 32/3; AshtangaSangrahaSutrasthana 26/17) 1. Sankar(Mixed Fomentation) 8. KarsuSveda (Trench Sudation) 2. Prastar (Hot bed fomentation) 9.KutiSveda (Cabin Sudation) 3.Nadi Sveda (Steam Catte Fomentation) 10.Bhu Sveda(Ground Bed Sudation) Trayodashavidha 4.Parisheka (Sprinkling) 11.KumbhiSveda( Pitcher Bed Sudation) (13 types) 5. Avagaha (Tub Bath Sudation) 12.KoopaSveda( Pit Sudation) 6.JentakaSveda (Sudatorium Sudation) 13.HolakaSveda ( Under bed Sudation) (Charak 7. AshmaghanaSveda (Stone Bed Sudation) Samhita Sutrasthana 14/39-40)

Table 1.Summarizing the classification of Svedan Karma described in various text of Ayurveda.

TANG / www.e-tang.org 2019 / Volume 9 / Issue 3 / e4 2 Scientific exploration on physiological basis of Svedana Karma (Sudation): A clinical application of heat stress. advised to take care of guidelines for indication and back, wrist and abdomen, feet, knee, calf. It is contraindication of Svedan Karma, along with season to beneficial in stiffness, excessive heaviness, numbness avoid adverse effect and to get adequate results. and in disease affecting in whole body (Charak Samhita Sutrasthana 14/20; Types of Svedan Karma AshtangaHridyamSutrasthana 17/25-26). Various types of Svedan have been described depending upon 3. Paralysis of the face, one limb, whole body or half of the method of heat application to induce sweat and the body the body. part on which heat to be applied, the dosha involved in 4. Distention of the abdomen, constipation and disease production, strength and Prakriti of patient and suppression of urine, dysuria, enlargement of scrotum, severity of disease. disease due to impaired digestion and metabolism. 5. Acharya Sushruta has mentioned some different Sarvanga Sveda indications of SvedanChikitsa like it is indicated as SarvangaSveda (whole body fomentation) is one modality Pashchat Karma after the removal of foreign bodies, among the methods for SaagniSvedan (fomentation) i.e. women who had obstructed delivery without any with direct application of heat on whole body by various complications or women who had a normal delivery, means. Heat generated or applied in Svedan Karma produces while it is indicated as Purva and Pashchat Karma in heat stress and initiates the thermoregulatory mechanism and case of piles, fissure and fistula in ano. (Sushruta produces various hemodynamic changes helps in excretion of Samhita Chikitsathana 32/17-19) metabolic wastes, enhanced immune mechanism. Contraindications of Svedan Karma Niraagni Sveda The Svedan involves heating of the body parts; it may In this type of Svedan no external heat is applied but heat loss aggravate the Pitta Dosha and hence, is harmful in certain from the body is checked or heat production in body is weak states of health. For the same reason in specific increased by advising exercise and other measures like conditions on which Svedan Karma should be avoided have residing in a warm chamber, wearing heavy clothing, been mentioned. excessive (ethanol) drinking, fear, anger, wrestling exposure to sunlight (Charak Samhita Sutrasthana 14/64-65). 1. Those who have taken too much alcohol, obese, The measures described under the NiraagniSveda stimulates thirsty or hungry, pregnant woman. sympathetic nervous system with release of epinephrine & 2. Those who are suffering from Raktapitta (bleeding nor epinephrine that increases BMR which in turn increases disorder), Kamala (jaundice), UdaraRoga (abdominal heat production, which significantly modulates the core disease), Timira(cataract), diarrhea, diabetes mellitus, temperature as a response to changing environmental and inflammation and prolapsed of the rectum. conditions. Thus NiraagniSveda corresponds to adaptive 3. PaitikaPrakriti individual, person having dry skin, in mechanisms of human beings. The causes of vitiation of state of anger or anxiety. The Pitta Prakriti SvedavahaSrotas are strenuous exercise, rage, exposure to individuals have dominance of Pitta Dosha that leads alternate heat and cold, anger, grief, fear etc. All these to more Ushna property (hotness) in them which described causes produce imbalance in heat production and causes profuse sweating. heat loss from the body and alter the sweating mechanism, 4. Weakness, emaciation, OjaKshaya (immune thus lead to imbalance in functional state of SvedavahaSrotas compromised state) and toxic conditions (Charak (Charak Samhita Vimanasthana 5/22). Samhita Sutrasthana 14/16-19; Sushruta Samhita Chikitsathana 32/24-25; Benefits of Svedan AshtangaHridyamSutrasthana 17/21-24). Svedan is a procedure which pacifies Vata and Kapha Dosha, reduces Meda (~ visceral fat), relieves stiffness, heaviness Special precautions and coldness of the body and produce sweating (Charak Svedan Karma should not be administered over testicles, Samhita Sutrasthana 22/1). It produces various beneficial heart and eyes. Even if it is very necessary to administer, it effects like liquefies the deposited Dosha (Dosha Dravatam), should be of mild type (Charak Samhita Sutrasthana 14/10; regulated Vata Dosha (Vata Niyamana), flexibility in body AshtangaHridyamSutrasthana 17/14) or after covering eye parts (Gatra Vinaman), augments metabolism (Agni Deepan), with clean clothes, balls of wheat flour, leaves of Kamala softness of skin (Tvaka Mardava),shining in skin (Tvaka (Nelumbonucifera), Utpala (Nymphea alba) or Palas (Butea Prasadana), increases appetite (Bhakta Shraddha), clears the monosperma) and heart should be covered with cool pearl channels (Srotosuddhi), removes drowsiness(Nidra-Tandra necklace, cool utensils, wet lotus. (Charak Samhita Nasha), improves joint motility (Sandhi Chesta)helps in Sutrasthana 14/11-12) The patient should be kept on removal and pacification of Dosha (Dosha ). wholesome diet, should abstain from exercise on that day. (Charak Samhita Sutrasthana 14/67) Since the exercise Indications of Svedan Karma produces the effects same as off Svedan induced by Svedan is beneficial both in healthy and diseased. When application of heat. Thus it may produce sign and symptoms carried out in healthy persons, it promotes the health while in of excessive Svedan and complications. diseased person; it is useful as an independent therapeutic procedure or as a preparation of the patient prior to the Management of Atisvedya Shodhana procedure. In the following diseases Svedan is The treatment of patients suffering from complication due to regarded as an effective treatment. over fomentation is the same as the summer regimen explain 1. Svedan is useful in cold, cough, hiccough, dyspnoea, in the CharakSutrasthana 6th chapter and intake of sweet, hoarseness of voice, spasmodic obstruction in the unctuous, and cold things in food. (Charak Samhita throat. Sutrasthana 14/15; AshtangaHridyamSutrasthana 17/20) In 2. Pain and stiffness in the ear, neck and head, sciatica, the treatment of excessive sudation is Stambhan therapy to

TANG / www.e-tang.org 2019 / Volume 9 / Issue 3 / e4 3 Scientific exploration on physiological basis of Svedana Karma (Sudation): A clinical application of heat stress.

check the loss of fluid. The sign and symptoms of Atisvedan • release of heat shock protein (excessive sudation) and the principles of management advised by Ayurveda are similar as heat exhaustion and heat • release of stress hormone stroke as mentioned in contemporary medicine. The medicated Ghrat (Sneha) used for Snehapan for internal Snehan and oil for as external Snehan get Mode of action of Svedan Karma readily absorbed and reaches into the SukshmaSrotas since it Under the effects of Svedan Karma on body it has been is lipoidal in nature and mechanism of action is same as mentioned that it augments Agni and Pitta Dosha, pacify the lipoidal drug delivery system (Singh N et al.,2011; Vata and Kaphadosha. Thus, it has regulatory effect over Chaudhary A et al.,2011). metabolism and restores physiological homeostasis (Sushruta Skin is dwelling site of Bhrajak Pitta Bhrajak Pitta helps Samhita Chikitsathana 32/22). The passive heat therapy and in absorption and further metabolism of topical drugs Svedan Karma causes increase in body temperature which (Sushruta Samhita Sutrasthana 21/10). Heat applied by produces following effects (Figure 1): Svedana enhances the drug absorption by subcutaneous • Hemodynamic changes vasodilatation, increasing permeability and enhances the metabolism of the drug by augmenting the Bhrajak Pitta.

Svedana Karma Produces heat stress

Sympathetic Heat shock protein stimulation released against heat stress

Adrenal Adrenal medulla cortex S t a b i l i z ed the steroid receptors and act via glucocorticoids Adrenaline & noradrenaline Glucocorticoids

Counteract the Actions of vasodilatation effect of glucocorticoid heat by producing vasoconstriction Heat production O n G I T Enhanced catabolism of Anti-inflammatory protein & fat Release Reduce stiffness, Calorigenic mucous & Weight loss pepsin pain & swelling (Guruta, Medakshya) Sheetghan(rem Subside oves coldness) Enhance appetite (Kshudha) Stambhta & Shool Kapha kshaya Enhance Pitta & Agni Pacify Vata (Aampachan)

Fig 1.Schematic representation of effect of Svedan

Hemodynamic changes therapy (daily hot baths over the course of 8 weeks). Various studies have reported the significant changes in BP, PR which signified hemodynamic effects of Svedan Karma Effect of Svedana karma on Glucocorticod (Thomas KN et al., 2017). Under the effects of Svedan Application of heat on the body during Svedana Karma is a Karma on body it has been mentioned that it augments Agni type of physical stress, which increases production of heat and Pitta Dosha. Thus, it has regulatory effect over shock protein in body that serves to stabilize the unbound metabolism (Sushruta Samhita Chikitsathana 32/22) and Pitta glucocorticoid receptors in cytosol. In their inactive state, and Rakta are in a relation of Ashrya-Ashryi that’s why these receptors exist in the cytosol within a topologically Svedan produces hemodynamic changes complex assembly of heat shock proteins that serve to (AshtangaHridyamSutrasthana 11/26). Brunt VE, et. al. stabilize the unbound receptor. The glucocorticoids have (2016) found that cardiovascular function and blood pressure myriad actions on the body that are primarily mediated via were remarkably improved after long-term passive heat intracellular receptors. Glucocorticoids passively diffuse

TANG / www.e-tang.org 2019 / Volume 9 / Issue 3 / e4 4 Scientific exploration on physiological basis of Svedana Karma (Sudation): A clinical application of heat stress. through the cellular membrane and bind to these receptors, a process which in turn promotes translocation to the nucleus. Possible mechanism of Sarvanga Svedan as Pradhan Within the nucleus, these ligand-activated receptors then Karma either interact with other transcription factors or bind to Purvakarma procedure includes Snehan and Svedan acts as specific DNA response elements with a resultant up- or an adjuvant in Panchkarma therapy and they bring the deeply down-regulation in the expression of various genes but the situated Doshah from Shakha (Dhatu) to Koshtha by Vriddhi exact mechanism of mode of action is yet not well and Vishyandana by Snehan and SrotomukhaVishodhan, understood but scientifically it can be said that it has possibly Paka of doshas by Svedana (Charak Samhita Sutrasthana hyperthermiceffect which produces haemodynamic changes 28/33). Vaman and Virechana karma then expel the vitiated and via increasing the secretion of glucocorticiod (Charles Dosha from Koshtha to out of the body. Svedan also have LR et al.,2003; Andrew HM et al.,2003). K. vangelonaet. Srotoshodhak effect as heat applied during Svedan karma, al, 2002 reported in their study a significant higher cortisol, produces haemodynamic changes like vasodilatation, adrenaline and noradrenaline values in workers of glass increase circulation. Which helps in excretion of deposited its manufacturing unit. So this study also suggests that waste products in minute Srotas (Sushruta Samhita glucocorticoid production is enhanced after exposure to heat Chikitsathana 32/22) (Figure 2) stress.

Svedana as Pradhan Karma

Increase in body temperature(Paka and Vishyandan of dosha)

Enhances the membrane permeability(Srotomukhavishodhan)

Enhance the exchange between intracellular and extracellular fluid

Allow the morbid/toxins/Mala deposited in the micro- channel (Sukshma Srotas) moves in interstitial fluid

From interstitial fluid comes into general circulation

By two mechanism morbid/toxins/Mala expel out

From general circulation morbid/toxins/Mala cutaneous vasodilatation (srotoshodhan) reached in the Koshtha

The waste product from this site removed enhances sweating and waste products By Vaman & Virechan Karma get excreted out of the body

Fig. 2 Schematic presentation of effects of Svedan as Pradhan Karma.

Effect of Svedan Karma on Heat shock protein in body temperature between 36 to 38o C with altered gene The scientists have identified a mechanism that allows cells expression. When cells are exposed to heat via various means to adapt their gene expression program to very small changes there is release of protein called HSPs. The HSPs are up in temperature. The scientist Florian Hyed suggested that the regulated intracellular proteins called molecular chaperones cellular thermometer is sensitive enough to react to changes that prevent protein aggregations and help transport repair

TANG / www.e-tang.org 2019 / Volume 9 / Issue 3 / e4 5 Scientific exploration on physiological basis of Svedana Karma (Sudation): A clinical application of heat stress. proteins ( Walter S. et al.,2002; Buchner J. et al.,2002 ) stress might serve as adjuvant to training for people who while the extracellular HSPs enhance the immune system cannot exercise because injuries or disabilities due to injury ( Binder RJ et al.,2014). osteoarthritis aging as needed because of old age injury or Recent research studies have suggested various health chronic disease. The exercise leads to increased to body benefits of HSPs which are released against stress including temperature due to increased metabolic rate that leads to heat stress eg. Enhanced glucose uptake at skeletal muscle, sweating and triggers to release chaperones (HSP) and thermo-protectants, protein synthesis, improved circulation, hormones. Ayurveda has considers exercise (Vyayam) under Anti-inflammatory effect in chronic inflammation associated the NiraagniSveda producing the same kind of benefits as many disorders, metabolic health (Riezman H et al., 2004; mentioned for SaagniSveda. Production of high levels of Hooper PL et al.,2009). heat shock proteins triggered by exposure heat and can also Passive heat stress produces significant physiological triggered by different kinds of environmental stress response and benefits almost same as exercise. The study conditions and water deprivation. As a consequence, the heat suggested (Iguchi M et al.,2012) that whole-body heat stress shock proteins are also referred to as stress proteins and their without exercise triggers cardiovascular, hormonal, and up-regulation is sometimes described more generally as part extra-cellular protein responses of exercise. Timely heat of the stress response (Jesper GS et al.,2003).

Samyak (proper sudation) Asamyak(improper sudation) Atisvedan (excessive sudation) (Charak Samhita Sutrasthana (Kashyapa Samhita Sutrasthana 23/16-17; (Charak Samhita Sutrasthana 14/14- 14/13;Kashyapa Samhita Sutrasthana Bhela Samhita Sutrasthana 22/13) 15;Kashyapa Samhita Sutrasthana 23/13; 23/13;AshtangaHridyamSutrasthana Bhela Samhita Sutrasthana 22/11; 17/14;Sushruta Samhita Chikitsathana AshtangaHridyamSutrasthana17/15;Sushru 32/23) ta Samhita Chikitsathana 32/24) Remission of sense of cold(Shitoparama), Absence of symptoms indicative of perfect Vitiation of Pitta Dosha(Pittakopa), diminution of pain (Shooloparama) Svedan, persistence of feeling of cold burning sensation(Daha), (Sheetata) fainting(Murchha), sense of exhaustion in the body parts (Sharirasadana) Reduction of stiffness in the body parts Absence of perspiration (Svedabhava) weak voice(Swaradaurbalya) (Stambhanigraha), reduced tone of the limbs (Angadaurbalya) Alleviation of sense of heaviness Pain in the joints(Sandhipeeda) (Gauravanigraha) Appearance of black or reddish patches(ShyavaraktamandalaDarshana). Improvement in the softness of the body Persistence of feeling of cold (Sheetata) Appearance of blisters(Sphota) parts exposed (Mardava) Giddiness (Bhrama) Appearance of sweating Symptoms indicative of vitiation of (Svedapradurbhava) Rakta(Arshakopa) Excessive thirst (Trishna) Remission of illness (Rogaprashamana) No desire of cold atmosphere General sense of exhaustion(Sadana) Desire for cold substances (Sheetabhiprayabhava) Fever(Jvara) (Sheetasevanechha) Vomiting(Chhardi)

Table: 2Characteristics of different degree (Samyak, Asamyak, Atisvedana) of Svedan Karma

Scientific exploration of various effects produced by Glucocorticoid increases lipase activity by potentiating Svedana Karma actions of other hormones for example growth hormone, (a) Reduces stiffness (Stambha) and pain (Shula) catecholamine’s, glucagon and thyroid hormone. All these In musculoskeletal disease like rheumatoid arthritis, joint hormones have lipolytic activity. Glucocorticoids favor inflammation causes swelling in the joint, which increases mobilization of fatty acids from adipose tissues to liver where when the joint is immobile; these results in limited mobility metabolism of fatty acids inhibits glycolytic enzymes and and tightening of muscles around the joints. Sitting and increases gluconeogenesis. This may be another possible sleeping for a long time worsen stiffness. Inflammatory mechanism via which Svedan help to reduce weight (Jain AK substances like cytokines hamper the signaling process of et al., 2009). glucocorticoid. Svedana leads to increased body temperature, (c) Increases appetite (Kshudha) which produces heat shock proteins and also enhances It enhances the digestive power (Agni). It may be due to secretion of glucocorticoids. Thus SamyakSvedana karma increase glucocorticoid activity against heat stress produced (appearance of features as quoted in Samhitas) inhibits in Svedan that enhance the secretion of gastric acid and inflammatory process by enhancing glucocorticoid activity pepsin. It may be understood as enhanced activity of Pitta & via heat shock protein and reduces swelling and pain. Svedan Agni at cellular level (SukshmaSrotas). The entire enhances the UshnaGuna in body hence pacify Vata and inflammatory product could be considered as Aam or toxins. KaphaDosha which helps in pacifying or reducing Stambha The enhanced glucocorticoid activity could be understood as (stiffness), Guruta (heaviness) etc. which have been produced augmentation of Agni at SukshmaSrotas(at cellular level) and due to deranged Vata and KaphaDosha (Charak Samhita vasodilatation causes the increased exchanged between Sutrasthana 2211). extracellular & intracellular fluid. So it helps in removal of (b) Relieves heaviness (Guruta) toxins and deposited Kleda in the body i.e. Srotoshodan

TANG / www.e-tang.org 2019 / Volume 9 / Issue 3 / e4 6 Scientific exploration on physiological basis of Svedana Karma (Sudation): A clinical application of heat stress. occurs. In animal experimentation it has been reported that repeated exposure to a mild stress (~400C) elicits positive Brunt VE, Howard MJ, Francisco MA, Ely BR, Minson CT. mitochondrial adaptation in skeletal muscle comparable to Passive heat therapy improves endothelial function, arterial those of exercise. The increased phosphorylation of AMPK stiffness and blood pressure in sedentary humans. J Physiol. and ERE1/2 electron transport and increase of HSP70 and 2016:(18):5329-42. HSP90 by 45% and 38% respectively (Poul SH et al., 2018). (d) Effect of Svedana on blood vessels Charles LR, Andrew HM. When Not Enough Is Too Much: Heat applied in Svedan causes vasodilatation that leads to fall The Role of Insufficient Glucocorticoid Signaling in the in blood pressure. However this decrease is within Pathophysiology of Stress-Related Disorders. Am J physiological limit since the glucocorticoids released against Psychiatry.2003:16(9). heat stress sensitizes the arterioles to the constrictor action of catecholamines specially nor-adrenaline (Jain AK et al., Hafen PS, Preece CN, Sorensen JR, Hancock CR, Hyldahl 2009). RD. Repeated exposure to heat stress induces mitochondrial adaptation in human skeletal muscle. J ApplPhysiol (1985). Contraindications of Svedana and glucocorticoids 2018:125(5):1447-1455. There are some conditions in which both Svedana Karma and administration of glucocorticoids are contraindicated like Hooper PL. Inflammation, heat shock proteins, and type 2 hunger, blurred vision, bleeding disorders, epilepsy, in diabetes. Cell Stress Chaperones. 2009:14(2):113-115. pregnant women etc. So this way we may assume that glucocorticoids released due to heat stress produced by Iguchi M, Littmann AE, Chang SH, Wester LA, Knipper JS, Svedan karma may be involved in various effects produced Shields RK. Heatstress and cardiovascular, hormonal, and by Svedana Karma (Tripathi KD et al., 2010). heat shock proteins in humans. J Athl Train. 2012:47(2):184- 90 Features of Ati (excess) Svedan burning sensation in the body, aggravation of Pitta, fainting Jain AK. Textbook of Physiology. Revised edition. (New (Murcha), heaviness of the body, pain in joints, blisters Delhi, India: Avichal Publishing Company), pp. 739-40, (Visphota), giddiness (Bhrama), tiredness (Klama),vomiting, 2009. thirst (Trshna). All symptoms of Atisvedan are similar to heat exhaustion or stroke. The treatment of patients suffering from Jesper GS, Torsten NK, Volker L. The evolutionary and complication due to over fomentation is the same as the ecological role of heat shock proteins. 2003:6:1025–1037. summer regimen explain in the Charak Sutrasthana 6th chapter and intake of sweet, unctuous, and cold things in food Krishanamurthy KH. Bhela Samhita of Bhela. Sutrasthana; (Charak Samhita Sutrasthana 14/15). Svedaadhyaya: Chapter 22, verse 1.Varanasi :ChowkhambhaVishwabharti, pp.95, 2013.

CONCLUSION Murthy Shrikantha KR. Editor (reprint edition) Sushruta Samhita of Sushruta. Varanasi: ChoukhambhaOrientalia, Svedana is majorly used procedure out of Shadvidha Chikitsa 2004. Upkrama and as Poorvakarma to Panchakarma procedures. The studies on heat stress have shown the similar effects as Murthy Srikantha KR, editor (9thEdition).AshtangaHridyam produced by Svedana karma mentioned in Ayurveda could be of Vagbhata. Varanasi: ChowkhambaKrishndas Academy. taken as evidence to understand the mechanism of action of Svedana karma in relation to heat stress, mitochondrial Pandey G. HaritaSamhit of Harita. (1st edition) Fourth sthana, adaptation, heat shock protein (HSP) and glucocorticoids. Svedavidhiadhyaya. Varanasi: Chowkhambhasanskrita Series, Different method of Svedan is based different heat providing 2014. media and measures as per disorders. The reason may be that the rate of heat transfer to the body is different in different Riezman H. Why do cells require heat shock proteins to methods of Svedana Karma. Further scientific research survive heat stress? Cell Cycle. 2004:3(1):60-62. studies could be performed on these parameters to understand various beneficial effect of Svedan Karma as per disorder as Sharma RK, Das B. Charak Samhita of Agnivesh. Varanasi: well as different type of Svedana Karma. ChoukhmbhaSanskrita Series office, 2008. ACKNOWLEDGEMENTS Singh N, Chaudhary A. A comparative review study of The authors have no conflicting financial interests. SnehaKalpana (Paka) vis-a vis liposome. AYU. 2011;32:103- 8

CONFLICT OF INTEREST Thomas KN. Harnessing heat for health: A clinical application of heat stress. Temperature (Austin). 2017: The authors have no conflicting financial interests. 4(3):208-210. Tiwari PV. Kashyapasamhita of Vriddhajeevakatantra. REFERENCES Varanasi: ChowkhambhaVishwabharti, 2013. Tripathi KD. Essentials of medial pharmacology (sixeth Binder RJ. Functions of heat shock proteins in pathways of edition). Jaypee Brothers medical publishers (p) LTD, 2010. the innate and adaptive immune system. Journal of Immunology. 2014:193 (12): 5765–71.

TANG / www.e-tang.org 2019 / Volume 9 / Issue 3 / e4 7 Scientific exploration on physiological basis of Svedana Karma (Sudation): A clinical application of heat stress.

Vangelova K, Deyanov C, Velkova D, Ivanova M, Stanchev V. The effect of heat exposure on cortisol and catecholamine excretion rates in workers in glass manufacturing unit, Cent Eur J Public Health. 2002:10(4):149-52.

Walter S, Buchner J. Molecular chaperones--cellular machines for protein folding. 2002:41 (7):1098-113.

TANG / www.e-tang.org 2019 / Volume 9 / Issue 3 / e4 8